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Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
10:52

Closure of a Patent Foramen Ovale PFO: An Intervention Sequence

Published on: December 23, 2022

4.1K

Patent foramen ovale-When to close and how?

Aurel Maloku1, Ali Hamadanchi1, Marcus Franz1

  • 1Department of Internal Medicine I, Cardiology, Angiology, Intensive Medical Care, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.

Herz
|August 31, 2021
PubMed

Insights

Patent foramen ovale (PFO) closure effectively reduces stroke risk in select patients. Interventional PFO closure is a recommended treatment for cryptogenic stroke, with a low number needed to treat to prevent recurrence.

Area of Science:

  • Cardiology
  • Neurology
  • Interventional Cardiology

Background:

  • Patent foramen ovale (PFO) is a common cardiac anomaly.
  • Cryptogenic/cardioembolic stroke in patients aged 16-60 with high-risk PFO warrants specific treatment strategies.

Purpose of the Study:

  • To evaluate the efficacy and safety of interventional PFO closure for stroke prevention.
  • To analyze the number needed to treat (NNT) for PFO closure in reducing stroke events.

Main Methods:

  • Review of current guidelines recommending PFO closure (Class A, Level I evidence).
  • Discussion of interventional PFO closure using double-disk occlusion devices and antiplatelet therapy.
  • Analysis of NNT data from key trials (RESPECT, CLOSE, REDUCE).

Main Results:

  • PFO closure is recommended for specific patient groups post-stroke.
  • NNT to prevent one stroke varies by trial and follow-up duration (e.g., 20 in CLOSE, 18 at 10 years).
  • The procedure is relatively easy to learn but requires careful execution to minimize complications.

Conclusions:

  • Interventional PFO closure is an effective strategy for preventing recurrent stroke in appropriate patients.
  • Individualized treatment decisions are crucial, especially for conditions beyond stroke like migraine, due to limited evidence.
  • Longer follow-up durations can reduce the NNT, highlighting the long-term benefits of PFO closure.

Keywords:
Cryptogenic ischemic strokeMigrainePFO-associated strokePlatelet aggregation inhibitorsSecondary prevention

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